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«Policy Number IC01 Policy Title INFECTION PREVENTION AND CONTROL POLICY Accountable Director Director of Infection Prevention and Control Author Lead ...»

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Due to the changing nature of this section of the policy, the current pandemic influenza guidance is contained in the Mersey Care NHS Trust Influenza Pandemic Contingency plan which is available on the trust website.


Human Immunodeficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) are all blood borne viruses. This means that they can be transmitted by blood transfusion or via blood contaminated (dirty) needles or by direct inoculation of blood as a non - accidental injury (violence e.g. deliberate bite). The other mode of transmission is via sexual intercourse, these viruses are also present in semen and saliva, (DOH 2000).

Prevention of the transmission of blood borne viruses is achieved by using sterile needles and syringes and avoiding unsafe sexual practices.

–  –  –

The transmission of blood borne viruses, patient-to-patient, or patient to health care workers can have serious consequences not only for the person infected but also for the trust because of health and safety legislation. In spite of guidance and education, many health care workers continue to be exposed to blood borne viruses from needle stick, sharp injuries and mucosal exposure, (Evans et al 2001).

Screening for Blood Borne Viruses

Research indicates that the prevalence of infection is increased in certain groups, such as intravenous drug users and residents of long term institutions;

it is therefore recommended that individuals falling into the higher risk groups are screen for BBVs on admission.

The following groups should be considered for and offered Blood Borne Virus screening.

• Those admitted to High Secure Services

• People who inject drugs (PWIDs)

• Men who have sex with Men,

• Those being admitted from Prison,

• Sex workers,

• Learning disabilities service users. (subject to assessment of risk behaviours) Any individual who is identified upon admission as falling into one of the higher risk groups and offered screening should be reported to the Infection Prevention and Control Team using the Managers Assurance checklist even if the offer was declined.

High risk community service users or those on short term admissions, whose stay will not be long enough for results and vaccination (HBV) to be completed, should be signposted to their G.P. Please record same in service users notes and inform Infection Prevention and Control team.

Key points to minimise risk of transmission of BBVs Use Standard Precautions as outlined in section 3.15 Everyone potentially presents a risk of infection. Therefore, consider all blood and body fluids to be infectious. Take your time to avoid spillages of blood or body fluids.

Use safety sharps devices wherever possible and exercise great care with all sharps to prevent puncture wounds, cuts or abrasions. Protect existing wounds, skin rashes or lesions, conjunctivae and mucosal surfaces from all blood and body fluids. When the use of sharps is essential, exercise particular care in handling and disposal of same. Only use approved sharps containers.

Never bend needles, Never put needles or other sharps into clinical or household waste bags. Never re-sheath needles.

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Control surface contamination by blood or body fluids by containment and disinfection. Wearing a plastic apron and disposable gloves use a body fluid spillage wipe, closely following the instructions. Dispose of clinical waste in appropriate waste stream.

Occupational Risk The risk of transmission of blood borne viruses is greater from patient to health care worker than from health care worker to patient.

Occupational risks of transmission of blood borne viruses arise from the possible exposure to blood or other body fluids or tissues contaminated with blood from an infected patient. Semen and breast milk may pose a risk of infection but exposure to these body fluids is rare in most health care settings.

Most cases of occupationally acquired HIV infection have arisen from percutaneous exposure to HIV infected materials, and of these the majority have followed injury from hollow needles in association with a needle or cannula being placed in a vein, e.g. venepuncture others have arisen through exposure of mucous membranes or non intact skin to blood.

Transmission of blood borne viruses may result from contamination of mucous membranes of the eyes or mouth, or of broken skin, with infected blood or other infectious material, and by human bites if the skin is broken.

There is no evidence of blood borne viruses being transmitted by contamination of intact skin, by inhalation or by faecal - oral contamination.

Venepuncture - See Venepuncture policy SD34 Decontamination of Spillages - See section 3.2 Decontamination of Equipment – Policy and Procedure for the Management and Decontamination of Medical Devices. SA19 Transportation of Specimens – See section 3.6 Human Immunodeficiency Virus (HIV) HIV is a virus. It can act very slowly in the body, so the effect of HIV in the body may take months or even years to show up. Someone infected with HIV may not show any signs of the virus for years and be unaware that they are infected

- but they will still be carriers of the infection and able to pass the infection on to others. Because of this dormant period it is impossible to say how many people are infected with HIV.

The disease if undetected and untreated progresses as follows: HIV infection After the initial infection with HIV an acute flu like illness may occur, and often the infected person is unaware of being unwell.

• HIV infection - asymptomatic

–  –  –

In this stage, which may last from 6 months to 10 years the infected person often has no observable signs or symptoms of infection.

• AIDS Related Conditions (ARC) This covers the various illnesses caused by the virus that do not fall into the strict definition of AIDS. e.g. serious weight loss, night sweats, pre-senile dementia.

• Acquired Immune Deficiency Syndrome AIDS is the case defined condition of an HIV infected person who develops one of a number of opportunistic infections that are associated with the syndrome. e.g. Pneumonia, salmonella infections, thrush, Kaposi’s sarcoma.

The risk of acquiring HIV infection following a needle stick injury or a bite is small.

Although HIV transmission may occur in healthcare settings most transmission


• by unprotected penetrative sexual intercourse with an infected person.

• by inoculation of infected blood. At present in the UK this results mainly from drug -users sharing blood contaminated injecting equipment.

• from an infected mother to her baby before or during birth or through breastfeeding.

There is no vaccine to prevent HIV.

Hepatitis B Virus (HBV) Hepatitis means inflammation of the liver. Viruses are the commonest cause but drugs and alcohol can also disturb the body’s immune system. Since the 1960s many hepatitis viruses have been identified and all cause similar acute illness but the differences are in long-term effect.

World-wide hepatitis B virus is the most common cause of liver disease and more than 2 million people die from it each year.

Hepatitis B is transmitted in the same way as HIV but it is far more infectious.

Hepatitis B infection can vary from having no noticeable symptoms to mild flu like symptoms, nausea, vomiting, fever, jaundice, hepatic failure coma and death within 8 weeks. Hepatitis B virus may be found in blood and virtually all body fluids of service users with Hepatitis B and carriers of the virus, but blood semen and vaginal fluids are the source of spread of HBV infection.

Transmission usually occurs by; Unprotected sexual intercourse.

• Injecting drug users sharing contaminated injecting equipment.

• From an infected mother to her baby before or during birth or through breast feeding.

• Needle stick injuries.

• Reuse / sharing of contaminated needles.

90 to 95% of adults who are infected with the Hepatitis B Virus will fully recover.

5 to 10% will become long term carriers. If the infection is acquired at birth, the

–  –  –

majority of these children will become long term carriers. A small number of chronic carriers may go on to develop chronic active Hepatitis, cirrhosis or liver cancer.

Hepatitis B is a major concern for health care staff who are exposed to blood and body fluids.

The most important measure that health care workers can take is to be vaccinated against HBV.

Hepatitis C Virus (HCV) Hepatitis C was first identified in 1989, and it has emerged as a significant public health problem. There are an estimated 170 million carriers of HCV world wide, and it is estimated that 216,000 people in England may be chronic carriers and the majority of these are unaware of their infection, (PHE 2013) Hepatitis C is an unusual hepatitis virus as 90% of infected people do not show any symptoms when first infected. About 10% of infected people will develop acute jaundice and others will develop cirrhosis between 20 and 40 years after the initial infection. A small proportion of these people will eventually develop liver cancer.

HCV is most frequently acquired by direct blood to blood contact, and the commonest mode of transmission in the UK is by sharing blood contaminated injecting equipment by injecting drug misusers. Both sexual and perinatal transmission can occur, though rarely. In the past transmission has occurred through transfusion of contaminated blood and organ transplant, but testing of blood donors and all products for HCV antibodies and heat treatment of blood products has greatly reduced transmission in this way, (PHLS 1999).

There is no vaccine for Hepatitis C virus.

Accidental Exposure Many occupational exposures occur through failure to follow recommended procedures and from careless disposal of sharps and clinical waste. There will however remain occasions when Infection Prevention and Control guidelines and safe working practices have been followed that accidents and malicious acts will occur.

Accidental exposure is identified as; Percutaneous injury - from needles, instruments, etc. which are contaminated with blood or body fluids.

• Exposure of broken skin - abrasions, cuts, eczema, etc. which has come into contact with blood or body fluids.

• Exposure of mucous membranes - eyes, mouth to blood or body fluids.

• Bites - puncture wounds inflicted by an individual known or suspected to have a blood borne virus.

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Please read the Occupational Health - Inoculation Injuries Policy IC2

6.22 First Aid – Following Potential Exposure to Blood or Body Fluids Immediate First Aid for sharps, bites and scratches: Bleed it - Encourage the wound to bleed. Do not suck or scrub the wound

• Wash it - Wash the wound with soap and water

• Cover it - Apply a waterproof dressing

• Report it - Report the incident to the manager and complete an adverse incident report form

• As soon as possible, attend your Occupational Health Department. If the injury occurs out of hours attend the nearest accident and emergency department for advice or treatment.

• If an injury has occurred from a known HIV, Hepatitis B or C patient, go immediately to the nearest accident and emergency and inform both Occupational Health and Infection Prevention and Control Department.

Mucous Membrane Exposure (Eyes)

• Rinse thoroughly with water or saline.

• Report the incident to the manager and complete an adverse incident report form

• Report to your Occupational Health Department as soon as possible BBV – Donor Testing Protocol The patient’s Responsible Clinician (RC) who will consider whether it is in the patient’s best interest to be asked to be tested for a third party, this is to protect the patient who may be disadvantaged by being tested.

If the patient declines testing or is mentally incapacitated, then no further action occurs.

6.23 Further Advice and Support If you have any questions or queries, you can contact the following people: Infection Prevention and Control Nurses on 0151 471 2635. Out of hours Contact Silver on Call.

• Infection Prevention and Control Doctor/Consultant Medical Microbiologist via Switchboard.

6.24 Other Trust Policies to be read in conjunction with this policy

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Policy and Procedure for the Management and Decontamination of Medical Devices. SA19 Waste Management Policy. SA22 Management and Control of Legionella Bacteria SA28 Health, Safety and Welfare Policy SA07 The HR Policy and Procedure for Learning and Development for Staff within Mersey Care HR05 Cleaning Standards Policy SA16 Inoculation Injury Policy IC02

7. Process for Monitoring Compliance and Effectiveness The Director of Infection Prevention and Control will present an annual report to the Quality Assurance Committee on compliance with this policy and its effectiveness.

In addition, the Trust Secretary will assess compliance in relation to the requirements for the population of the External Assurance Register annually and report the findings to the Audit Committee.

Infection Prevention and Control Clinical Area Assurance Checklists are completed in all clinical areas which include evidence of hand hygiene training (See Appendix 6). These are sent by the managers, monthly to their respective Modern Matron who collates the data which is then sent to the DIPC. These checklists are also copied to the Infection Prevention and Control team who monitor compliance levels particularly with regard to hand hygiene training for frontline staff.

8.Glossary of Terms Infection This is when germs in or on the body have started to multiply and/or invade a part of the body where they are not normally found. The body develops a reaction leading to disease or illness.

Cross Infection Is the transfer of germs from one person to another, this may or may not lead to illness or disease.

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